Pseudobulbar Affect

Pseudobulbar Affect (PBA) is a neurological disorder that causes uncontrollable bouts of emotion such as laughing and crying. PBA can affect people at any age, but generally accompanies another neurological disease such as Multiple Sclerosis or Alzheimer’s, according to PBAinfo.org. This website is dedicated to raising awareness about this little-known and misunderstood disorder.

In people with Alzheimer’s disease (AD) and dementia such a diagnosis can be particularly difficult. PBA is common, affecting between 10–40 % of people with AD but is frequently not detected or is misdiagnosed. According to figures from The National Stroke Association, 20% of stroke survivors will experience PBA in the year following their stroke.

Differentiating PBA from depression and other behavioral disturbances in AD and dementia is helpful to identify a specific cause of their symptoms and assist with appropriate management. A person can have both PBA and depression, but they are two separate diagnoses.

Symptoms

Emotional outbursts that are sudden and uncontrollable.

Outbursts can include laughing, crying, and can last as long as a few minutes, or be as short as a few seconds. According to the American Stroke Association, these episodes can strike a person up to 100 times a day.

Besides being out of the control of the person experiencing them, the emotional spells caused by PBA may not reflect the actual feelings of that individual. A person may cry in response to a joke or have a laughing fit during a sad time.

Outbursts may also be overly exaggerated, for example a person may display a bout of boisterous laughter in response to a neutral or mildly humorous situation.

Causes

PBA is thought to be triggered by a traumatic injury, or a neurological disease that affects the parts of the brain that deal with the processing and expression of emotions.People with PBA suffer from an injury-induced, “short-circuiting” of the signals that govern their emotions.

Some health problems that can give rise to PBA include:

A stroke

Multiple Sclerosis

Alzheimer’s disease

Parkinson’s disease

Brain trauma

Lou Gehrig’s disease (ALS)

Diagnosis

PBA is a separate neurological disorder that can be diagnosed and treated independently of other health related diagnoses. Diagnosing PBA can often be challenging as the symptoms of this disease closely mirror those of depression and other mood disorders.

Current diagnostic methods for PBA are relatively sparse. There are essentially the two tests a physician may utilize to identify if person has PBA:

The Pathological Laughter and Crying Scale

The Center for Neurologic Study-Lability Scale.

These tests are designed to help a physician determine how often and severe PBA outbursts are in a person and what their primary triggers are.

If you feel that you’re caring for someone who may have undiagnosed PBA, discuss the symptoms with their doctor.

Supporting a Loved One with PBA

PBA can have an enormous impact on a person’s social life. Emotional occurrences caused by the disease can be distressing and can interfere with interpersonal relationships.

For caregivers of people with PBA, it can be difficult trying to deal with a person who feels isolated and alone because of their disease.

PBAinfo.org offers a tips for caregivers to help them interact positively with their loved ones:

Let them know that you support them and they are not alone. Reassure them that many people suffer from the symptoms of PBA.

Remind them that their outbursts are caused by a physical disease, not a mental condition.

Indicate your willingness to listen to their frustrations and concerns.

Keep an “episode diary.” By recording PBA episodes, you can ensure better communication with your doctor and help him or her make an accurate diagnosis.